Path to Recovery After Heart Surgery

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1 Path to Recovery After Heart Surgery

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3 Contents Introduction... 1 Page Welcome to 5 South... 2 How will I feel after my surgery?... 2 What to expect after surgery... 3 Eating well after surgery... 6 Confusion or Delirium... 8 Exercise and activity Medications At home Incision care Leg and ankle swelling Medications at home Managing pain at home Managing constipation at home Iron Sleep Emotions Exercise and activity at home Save your energy Eating heart healthy at home Diabetes Be smoke-free When am I able to have sex? Cardiac rehabilitation When to call for help Weight Diary My questions... 62

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5 Introduction It takes time and effort to recover after heart surgery. You are now on the path to recovery from your heart surgery. This book is your guide for 6 to 8 weeks after your surgery and includes information on: what to expect after your surgery what food to eat after surgery what exercises to do after surgery what to avoid after surgery how to take care of your incisions when to get medical help cardiac rehabilitation programs We hope this book helps you take part in your own care and well-being. Any member of the health care team will be pleased to speak with you at any time no question is too small to ask. Page - 1

6 Welcome to 5 South How will I feel after my surgery? The first few days on 5 South you may feel: Very tired and weak. This is normal and will pass. A sore and dry throat. This is from the breathing tube used during surgery. Try sucking on ice chips to relieve the discomfort. The sensation of your heart beating in your chest. This will happen more often when you lay in bed. You should not feel a very fast, pounding heart beat. Tell your nurse if you feel dizzy or like you have just run a race. Your heart monitor will alert staff if your heart is beating irregularly. You will get medications to treat this. Pain when breathing deeply or coughing. You will get pain medication to treat this. Pain in your incisions. The pain may feel like burning, itching or tingling along your incisions. The incisions can also feel numb. You will get pain medication to treat this. Shortness of breath with activity. Your shortness of breath should be easily relieved by slowing down or sitting down. Tell your nurse if you are short of breath when resting or lying in bed. Practice the breathing and coughing exercises that the physiotherapist will teach you. Trouble sleeping. The ward is busy and noisy. Try getting naps when ever you can. Forgetful and unable to think. Surgery can be stressful. This will likely pass. Constipated the first 2 to 3 days after surgery. You should have your first bowel movement within 3 days and go back to your normal bowel routine. Page - 2

7 The staff on 5 South will work with you to make a plan for your care. Your goals on 5 South include: Advancing your diet from fluids to a healthy heart diet. Teaching you how to sit up in bed or a chair. Taking short walks with staff at first and then by yourself when you are ready. Teaching you breathing exercises. Teaching you exercises for home. Keeping your bowels moving. Reviewing your home medications. Referring you to a cardiac rehabilitation centre of your choice. What to expect after surgery The information in the chart on pages 4 and 5 will help you learn what to expect while in the hospital and how to prepare to go home. Note: These are guidelines only. Each patient s recovery is different. Page - 3

8 GOALS Pain Management Activity Nutrition Post-op Day 1 You will get pain medication regularly. Let your nurse know if you need stronger pain medication. You will: do deep breathing and coughing exercises do calf exercises sit in a chair Support your chest. Clear fluid diet. (Juice, Jell-O, clear tea or coffee, ginger ale, broth soup) Post-op Day 2 Start asking for pain medication when needed. Do not let pain get severe. You will: do deep breathing and coughing exercises. sit in a chair with each meal walk with a nurse or physiotherapist Bring shoes that fit. Support your chest. Full fluid diet. (Milk, pudding, hot cereal, cream soup) Bowel and Bladder Bathing You will have a urine catheter. You will start to pass gas. You will have help with bathing at the bedside. The urine catheter is removed. All urine is measured. You will be passing gas. Daily weight. You will have help with bathing at the bedside. Going home help from family and friends Bring in glasses and hearing aids. Let the nurse know of any concerns about going home, including barriers you think may affect your family/friend s discharge home. Bring: shoes that are supportive list of medications from home music and headphones Let the nurse know if your family or friend is having trouble sleeping in the hospital. Page - 4

9 Post-op Day 3 Continue to ask for pain medication when needed. You will: sit in a chair with each meal get up to the bathroom independently, if able walk by yourself 3 times a day Support your chest. Full fluid diet. (Milk, pudding, hot cereal, cream soup) All urine is measured. You will have a bowel movement. If not, let your nurse know. Daily weight. You will have help with bathing if needed. Post-op Day 4 Continue to ask for pain medication when needed. You will likely need less pain medication to feel comfortable. You will: sit in a chair with each meal walk by yourself 3 times or more a day practice stairs with a physiotherapist Support your chest. Solid diet. Low cholesterol, no added salt. No concentrated sugar diet if you have diabetes. You will have a bowel movement. If not, let your nurse know. Daily weight. You will bathe independently. Post-op Day 5 Tylenol will likely control most of your pain. A prescription for stronger pain medication will be given for home. You will be independent with no assistance, including walking and getting in and out of bed. Support your chest. Solid diet. Low cholesterol, no added salt. No concentrated sugar diet if you have diabetes. You will have at least one bowel movement before discharge. You will bathe independently. Help your friend/family member to walk if approved by nurse or physiotherapist. Bring in loose clothes to wear home. Arrange for pick up tomorrow. Ask nurse expected time of discharge. Home! Bring wheelchair up from front entrance to bring family member downstairs. Page - 5

10 Eating well after surgery Your body is working hard to recover and heal so eating well is important. Your appetite may be poor at first but should improve day by day. Make sure you eat foods with protein at your meals not just the liquids like tea and juice. Foods with protein help the body to heal and include: fish, chicken, turkey and other meats legumes such as kidney beans, chick peas and lentils nuts, nut butters and seeds (unsalted) milk and alternatives milk, yogurt and cheese If you feel too full to finish your meals, snack between meals and in the evening. Here are some snack ideas: crackers and partly skimmed milk cheese crackers and peanut butter pudding sandwich yogurt Page - 6

11 You may also try a nutrition supplement to help increase your intake of calories and protein. Examples of nutrition supplements include: Ensure Boost Carnation Breakfast Essentials They are available in the hospital and at most grocery stores or pharmacies. If your appetite does not improve while you are in the hospital, ask to see the Registered Dietitian. If your appetite continues to be poor at home and you are losing weight, contact your family doctor. Once your appetite returns, it is important to follow the heart healthy eating guidelines on pages 43 to 49. Page - 7

12 Confusion or Delirium Confusion, also called delirium, is a sudden confused state of mind. It may occur during illness or after an operation. It is more common in elderly patients who have become ill and go into the hospital. Signs of delirium: unable to remember where you are unable to pay attention restless or upset seeing or hearing imaginary things sometimes okay but at other times very confused What are the causes of delirium? Some of the causes of delirium are medications, infection and being in the hospital. You are more likely to get delirium if you have any of these conditions: memory or thinking problems severe illness dehydration problems with seeing or hearing If you develop delirium, the health care team will try to figure out what is causing the confusion, which usually means doing tests and asking your family questions about you before you came to the hospital. Page - 8

13 How is delirium treated? Treatment may include medications. There are also many things family members can do to help. How can my family member help? 1. Promote healthy rest and sleep Reduce noise, distractions or overstimulation. Encourage use of eye covers, earplugs or music headphones. Add comfort with a familiar pillow, blanket, warm drink or back rub. If needed, family members may stay overnight. 2. Promote hydration and healthy eating Bring in favourite foods if you are not eating well. Help fill out the daily menus. Encourage and help with eating at mealtimes. Encourage fluids after checking with the nurse. 3. Promote physical activity and discourage immobility Encourage the patient to sit up and walk as directed by the health care providers. Ask the nurse about how they can help with exercises and activities. Page - 9

14 4. Promote healthy hearing and vision Encourage the use of hearing aides and make sure the batteries are working. Encourage the use of eye glasses. Make sure it is the right pair and they are clean. 5. Promote mental stimulation Remind the patient of the date, time and reason he or she is in hospital and how long they have been there. Arrange for familiar people to visit. Talk about current events and topics. Read aloud or play mentally stimulating games. Bring in pictures of family and friends and encourage conversation. Delirium often clears in a few days or possibly weeks with most people. Some may not respond to treatment for many weeks. You may continue to have problems with memory or thinking after you leave the hospital. Page - 10

15 Exercise and activity Right after your surgery, rest is very important. You will begin more activity by doing some of your own personal care and getting out of your bed into a chair. You will slowly increase the amount of walking you do. Stop, rest and tell your nurse or therapist right away if you have these feelings during activity: chest pain or discomfort (After heart surgery some chest discomfort may be normal. You should not have angina symptoms.) pressure or tightness in your chest shortness of breath or trouble breathing lightheaded or feeling faint palpitations or feeling your heart is going very fast clicking in your sternum or breastbone While on 5 South, your physiotherapist will teach you two ways to measure exercise and activity: 1. Measure how hard you feel you are working. See The Rate of Perceived Exertion (RPE) Scale on page Measure your pulse, also called heart rate. Your pulse is how many times your heart beats in a minute. If you have a heart rhythm called atrial fibrillation, your pulse will be irregular. You will use the Rate of Perceived Exertion (RPE) Scale on page 12. Page - 11

16 The Rate of Perceived Exertion (RPE) Scale The Rate of Perceived Exertion or RPE Scale is used to measure how easy or hard you find an activity. The scale has numbers from 0 to 10. For example, 0 (nothing at all) would be how you feel when you are resting in a chair. Try to reach level 3 to 4 on the RPE Scale when you exercise. When you use this scale, include any symptoms such as shortness of breath and how tired you feel in your legs and body. The Rate of Perceived Exertion (RPE) Scale 0... Nothing at all, very easy 1... Very slight 2... Slight 3... Moderate 4... Somewhat hard 5... Hard Very hard Very, very hard (almost maximal) Maximal Page - 12

17 To take your pulse, follow these steps: 1. Rest for 15 minutes. 2. Put 2 fingers of one hand on your opposite wrist, just below the thumb. If you have trouble finding your pulse, talk to your nurse or therapist. 3. Count your pulse for 15 seconds. This is your resting 15 second pulse rate. 4. To guide your level of exercise, take your pulse during the activity or exercise: You want your pulse to increase 5 beats in 15 seconds. If you take a beta blocker medication, your pulse should only increase 3 beats in 15 seconds. A beta blocker medication lowers your heart rate. See page 20 for information on beta blockers. If your pulse is higher than these guidelines, you need to slow down or rest. Your pulse should never be higher than 30 beats in 15 seconds or 120 beat in a minute. 5. Tell your doctor, nurse or therapist if you feel any changes in your pulse, such as: pauses sudden fast beats irregular beats Use your pulse to judge if you are doing enough exercise. Gradually increase your activity when your heart rate or pulse is not increasing while you exercise. Page - 13

18 Medications Many of your medications may change after surgery. You will get new prescriptions before you leave the hospital. There are no repeats on these prescriptions. Your family doctor will review and renew these prescriptions. Your nurse will review your medications with you before you leave the hospital. Make sure you know what changes have been made. If you have any questions please ask. Page - 14

19 At home This section of the book has information about what you will need to do at home to keep healthy. Incision care Your incisions should be dry and have no open areas after the staples have been removed and sutures dissolved. Any drainage from your incisions should be clear and in small amounts. The muscles in the front of your chest will be tender for at least 3 months after surgery. Your bones will start to heal within 6 to 8 weeks after surgery but may take up to several months to heal completely. During the first few weeks you are home, your incision area may be bruised. It may also be sore, feel numb or itch. Your incisions will heal and lighten in colour over several months. You may notice a lump at the top of your chest incision. This is normal and will disappear over time. Tips to help your bones heal the first 6 to 8 weeks after surgery Do Not: lift, push or pull anything heavier than 10 pounds or 4.5 kilograms raise your arms over your head to do work such as cleaning out a cupboard sit behind an airbag until your surgeon gives you permission Do: hug a pillow or rolled up blanket when you cough to provide support to your chest Page - 15

20 Tips to prevent infection: Keep your incisions clean with mild soap and water daily. Do not scrub your incisions. Pat dry. Have warm showers instead of baths. Do not let the water hit your chest. Turn your back to the shower water. Do not pull sutures if you see them they will dissolve or fall out on their own. Do not use any lotions or creams on any open areas or scabbed areas unless prescribed by your doctor. Do not pick at any scabs forming. Let them fall off naturally. Contact your heart surgeon if you have: increased drainage from your incisions, redness or swelling in your incisions new pain in your incisions fever or chills with a temperature above 38 o C or 100 o F flu-like symptoms with any type of discharge from your incisions Page - 16

21 Leg and ankle swelling Your feet and ankles may swell for several weeks after your surgery. This swelling should decrease when you elevate your feet, especially at night when you sleep. The swelling can last up to a month. Tips to decrease swelling in your feet and ankles when at home: Elevate your feet when you rest. Do not cross your legs. Wear TED support stockings or anti-embolism stockings given to you in the hospital. If you did not get these talk to your family doctor or the staff at the Cardiac Health and Rehabilitation Centre at Walk daily. Do your feet, ankle and leg exercises daily. Do not stand in one position for a long period of time without moving your feet. Weigh yourself once a day in the morning and after you first use the bathroom. Use the Weight Diary on page 60 to record your weight. Page - 17

22 Medications at home Medications are used for many reasons. You will have your own medication plan to follow based on your condition. You may need medication to: lower your blood pressure help your heart beat more slowly and strongly relax and open up the blood vessels help keep your heart beat in a regular rhythm manage your blood cholesterol levels increase the iron in your blood help keep your bowels moving regularly remove excess water Take your medications as prescribed, even when you feel better. You may need to continue some medications to help you stay well. Never take anyone else s medications. Do not share your medications with other people. The chart on the next few pages lists the common medications used to treat heart disease. Medication names are listed by their generic name first and then some of the common trade names in brackets. Page - 18

23 Type of medication Ace Inhibitors Generic and Trade Names (Generic names are listed first with no capital letters) benazepril (Lotensin ) captopril (Capoten, Apo-Capto ) cilazapril (Inhibace ) enalapril (Vasotec ) fosinopril (Monopril ) lisinopril (Prinivil, Zestril ) perindopril (Coversyl ) quinapril (Accupril ) ramipril (Altace ) trandolapril (Mavik ) What medication does helps slow down the further weakening of the heart treats heart failure lowers high blood pressure improves blood flow to and from the heart delays or prevents kidney damage from diabetes Angiotensin Receptor Blockers (ARB s) candesartan (Atacand ) eprosartan (Teveten ) irbesartan (Avapro ) losartan (Cozaar ) telmisartan (Micardis ) valsartan (Diovan ) olmesartan (Olmetec ) lowers blood pressure treats heart failure improves blood flow to and from the heart Page - 19

24 Type of medication Generic and Trade Names (Generic names are listed first with no capital letters) What medication does Beta Blockers acebutolol (Sectral, Monitran ) atenolol (Tenormin ) bisoprolol (Monocor ) carvedilol (Coreg ) labetalol (Trandaxe ) metoprolol (Lopressor ) nadolol (Corgard ) pindolol (Visken ) sotalol (Sotacor ) timolol (Blocadren ) lowers heart rate and blood pressure helps to treat and prevent angina helps to prevent a heart attack in patients who have had one keeps your heart beat in a regular rhythm Calcium Channel Blockers Heart rate controlling: diltiazem (Cardizem SR, Cardizem CD, Tiazac ) verapamil (Isoptin, Isoptin SR, Chronovera ) lowers heart rate and blood pressure helps prevent and treat angina keeps your heart beat in a regular rhythm Non-heart rate controlling: amlodipine (Norvasc ) felodipine (Plendil, Renedil ) nifedipine (Adalat PA, Adalat XL ) lowers blood pressure helps prevent and treat angina Page - 20

25 Type of medication Diuretics Generic and Trade Names (Generic names are listed first with no capital letters) amiloride hydrochloride (Amilide ) furosemide (Lasix ) hydrochlorothiazide (Apo/ Hydro / Novo-Hydrazide ) indapamide (Lozide ) metolazone (Zaroxolyn ) spironolactone (Aldactone ) What medication does removes excess fluid from the body which reduces swelling lowers high blood pressure Lipid Lowering Agents Statins: atorvastatin (Lipitor ) fluvastatin (Lescol ) lovastatin (Mevacor ) pravastatin (Pravachol ) rosuvastatin (Crestor ) simvastatin (Zocor ) lowers total cholesterol and LDL cholesterol (bad cholesterol) lowers triglycerides increases HDL cholesterol (good cholesterol) Fibrates: bezafibrate (Bezalip ) fenofibrate (Lipidil Micro, Lipidil Supra, Lipidil EZ) gemfibrozil (Lopid ) Others: ezetimibe (Ezetrol ) nicotinic acid (Niacin) Page - 21

26 Type of medication Generic and Trade Names (Generic names are listed first with no capital letters) What medication does Nitrates Long acting: isosorbide dinitrate (Isordil ) nitroglycerin patch (Nitro-Dur, Minitran ) isosorbide mononitrate (Imdur ) Short acting: nitroglycerin spray (Nitrolingual Pumpspray ) nitroglycerin sublingual tablets (Nitrostat ) relaxes blood vessels to reduce the work of the heart treats and prevent angina relaxes blood vessels to reduce the work of the heart gives immediate relief of your angina pain Platelet Inhibitors and Anticoagulant Medications Other acetylsalicylic acid (Aspirin, Entrophen, Novasen, ASA) clopidogrel (Plavix ) warfarin (Coumadin ) amiodarone (Cordarone ) digoxin (Lanoxin ) hydralazine (Apresoline ) prevents blood clots or platelets from sticking together helps to reduce the chance of another heart attack you may be on more than one of these keeps your heart beat in a regular rhythm lowers heart rate and strengthens the heart lowers blood pressure and treats heart failure Page - 22

27 Sometimes a medication can be a combination of 2 different medications. Here is a list of some of these medications. Brand name Accuretic Altace-HCT Aldactazide Apo -Triazide Atacand Plus Avalide Caduet Coversyl Plus Coversyl Plus HD Coversyl Plus LD Diovan-HCT Hyzaar Hyzaar DS Inhibace Plus Micardis Plus Olmetec Plus Prinzide Tenoretic Teveten Plus Viskazide Vaseretic Zestorectic Generic names of medication in product quinapril and hydrochlorothiazide ramipril and hydrochlorothiazide spironolactone and hydrochlorothiazide triamterene and hydrochlorothiazide candesartan and hydrochlorothiazide irbesartan and hydrochlorothiazide amlodipine and atorvastatin perindopril and indapamide perindopril and indapamide perindopril and indapamide valsartan and hydrochlorothiazide losartan and hydrochlorothiazide losartan and hydrochlorothiazide cilazapril and hydrochlorothiazide telmisartan and hydrochlorothiazide olmesartan and hydrochlorothiazide lisinopril and hydrochlorothiazide atenolol and chlorthalidone eprosartan and hydrochlorothiazide pindolol and hydrochlorothiazide enalapril and hydrochlorothiazide lisinopril and hydrochlorothiazide Page - 23

28 Tips to help you manage medications: Know the names of your medications, how much and when you need to take. Use a pill organizer or blister pack (prepared at your pharmacy) to help you remember to take your medication. When at home do not stop any medication unless told by your family doctor, cardiologist or heart surgeon. Speak to your doctor or pharmacist when the medication label says 0 repeats. This does not mean you are to stop this medication, it may mean that it needs to be re-ordered by your doctor. Your doctor may want to see you to monitor your health. Bring all your medications in their original bottles to your doctor appointments. Wear a Medic Alert identification if you are on warfarin, have a permanent pacemaker, implantable cardiodefibrillator device (ICD) or a mechanical heart valve. Ask your community pharmacist for a medical alert identification form or - visit If you are going to be away from home, carry enough medication with you so you do not miss a dose. Read the medication handouts from the pharmacy. These handouts tell you about the problems your medications can cause and when to contact your doctor. Page - 24

29 Get rid of any medications you no longer use. Take your unused medications to your pharmacy for environmentally safe disposal. Do not throw medication in the garbage, down the sink or toilet. Call your doctor, nurse or pharmacist if you have any questions about your medication. Carry an up-to-date list of your medications and the amounts you take with you all the time. Do not stop taking your medications without talking to your doctor first. Page - 25

30 Managing pain at home Take your pain control medication when you are in pain. Follow the directions on the label. Take pain control medication before the pain is severe. Too much pain will slow down your recovery. When you have pain it is hard to sleep, eat or be active. You should be able to increase your activity as your pain decreases. Call your surgeon if you have increased pain in your incisions. Tips to help you take your pain control medication: Follow the directions on the label. Usually you can take 1 or 2 pain medication tablets every 4 to 6 hours. Try taking one tablet of pain medication initially. Give the medication 60 minutes to work. If you still have pain after 60 minutes, then take the second tablet. If the pain control medication makes you dizzy or dopey, take less pain control medication the next time you need it. Do not drink alcohol while you are taking pain control medication. Do not drive or operate machinery while you are taking pain medication. If you feel dizzy, sit or lie down until you are no longer dizzy. Then get up slowly. Narcotic pain medication such as codeine and oxycodone can cause constipation. Plain acetaminophen (Tylenol ) does not cause constipation. See page 28 for tips to help manage constipation. Page - 26

31 Angina pain You should not have angina pain. If you think you have angina pain, do the steps in the chart below. 1 Rest Stop what you are doing right away. Sit or lie down. This will decrease the work of the heart. 2 Relax Take slow, deep breaths. 3 Take nitroglycerin Take your nitroglycerin as prescribed: take your 1 st dose of nitroglycerin. Spray or place tablet under your tongue. if the chest pain does not go away after 5 minutes, take a 2 nd dose. if the chest pain is still there after 5 or more minutes (now a total of 10 minutes), take a 3 rd dose. 4 Get help If you still have chest pain or discomfort after taking 3 nitroglycerins at 5 minute intervals (now a total of 15 minutes): have someone call 911 for an ambulance right away. do not drive yourself to the hospital. Page - 27

32 Managing constipation at home Constipation is straining or pushing to have a bowel movement or pass stool. You have constipation when your pattern of bowel movement changes and you find it hard to pass stool. Other signs of constipation: Your stomach feels bloated. You do not feel hungry. You have nausea. You feel the urge to have a bowel movement, but when you sit on the toilet nothing happens. You need to push a lot to have a bowel movement. Your stool is very hard. Keep a diary of your bowel movements at home for the first few weeks after surgery. It is common to have changes in your bowel movements during this time. At home, if you have not had a bowel movement for 2 days, take a medication for constipation. Medication for constipation Stimulant laxatives Use stimulant laxatives only when needed. When stimulant laxatives are used for too long, your bowel becomes weak and lazy and it is hard to get bowel control back. Stimulant laxatives help your bowel muscles to push stool out. You may feel some cramps as the bowel muscles begin to work. It may take 6 to 12 hours to have a bowel movement after taking a stimulant laxative. Suppositories usually work within 15 minutes. Page - 28

33 You can buy the recommended laxatives below at the pharmacy without a prescription: Bisacodyl brand names include, Apo -Bisacodyl, Dulcolax, PMS-Bisacodyl, Correctol and Feen-A-Mint Senna brand names include senokot Stool softeners Stool softeners help the stool hold water and become soft. Taking a stool softener regularly can help prevent constipation. It may take 1 to 4 days before your stools become softer. Recommended stool softeners are: Docusate brand names include Colace and Soflax. Start by taking one capsule of a stool softener with breakfast and one capsule with dinner. You may increase to 2 capsules with each meal if needed. PEG (polyethylene glycol) brand names include Lax-a-day, PegLax. Add ½ to 1 package or 1 to 2 teaspoonfuls of powder (if bought in bulk) to any fluid and drink daily. PEG is tasteless and causes little gas. Tips on how to prevent constipation Eat high fibre foods such as prunes, whole grains, fruits and vegetables. A soft stool contains a lot of water. Drink 1½ to 2 litres or 6 to 8 cups of water a day. This will help you to have a soft stool. If you are not allowed to drink a lot of fluids, talk to your health care provider. They can help you find a way to prevent constipation that is safe for you. Start and maintain a regular walking and activity program. Talk to your family doctor or pharmacist if you have questions or concerns about constipation or how to treat it at home. Page - 29

34 Iron You may be given a prescription for iron when you go home. Iron helps the body make blood. If your blood level (hemoglobin) is low, you may feel tired and weak. Tips about iron Iron can easily upset your stomach. To avoid stomach upset, take your iron with a meal or snack. Iron can cause severe constipation or severe diarrhea. Iron makes your stool or bowel movement black. Sleep Sleep and rest are very important to your recovery. However, trouble sleeping is common after heart surgery. It will take time to return to good sleep patterns. It is common to take short naps after surgery. With time you will return to sleeping all night. Tips to help you sleep If you cannot sleep at night because you are in pain, take your pain medication 15 to 30 minutes before you go to bed. Use pillows to arrange your body in comfort. Sleep upright in a recliner if you find it more comfortable or easier to breathe. Make your home quiet turn off the ringer on the phone. Listen to your body. Take naps during the day as needed. To return to nighttime sleeping, limit your daytime naps when you feel strong enough to do so. Talk to your family doctor if you feel you need help sleeping. Page - 30

35 Emotions Why do I feel emotional sometimes? Recovery from heart surgery may leave you feeling tired and weak. This can affect your emotions and cause you to feel overwhelmed. Your symptoms may include: crying easily feeling irritable, angry, frustrated, sad or blue feeling anxious not being able to concentrate You may notice a change in these emotions over the next 8 to 12 weeks. Tips to help you manage your emotions: Get plenty of rest even if it means resting during the day. Space out your activities to prevent feeling overwhelmed. Allow others to help you prepare meals, shop and do household chores, both inside and outside of the house. These emotions should not last. If they last for 2 weeks in a row, call your family doctor or nurse in the Cardiac Health and Rehabilitation Centre at Page - 31

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